TKR Midwest Girl's New Knee Journey - A Year Later.

[Wednesday]

I had both knees replaced, and after leaving the hospital, the only way I could sleep was on my side. I used a pillow between the legs for additional comfort. At first I could only sleep on the right side, and after a week or two, I felt comfortable on my left side. It was kind of awkward turning because I wanted to be sure I wasn't twisting anything.

Then, suddenly, one day I realized I didn't need the pillow. Now at seven weeks I'm sleeping on both sides and turning normally.

 

[midwest girl]

Thank you @Wednesday for that info. Getting to laying on my surgical side is much easier than getting to lay on my non-surgical side. Only because my quads are so dead. But I just use a leg lifter to help me a I can manage just fine. I can't lay on each side very long but it's enough to get some pressure off my lower back. My next challenge is trying to get my pain under control. We are basically starting over and introducing narcotics back into my system. Due to severe constipation I've had no narcotic pain relievers since Thursday, just Tylenol and ibuprofen. But I can't do that anymore as my sole pain relief (Outside of icing), the pain is just getting to be too great.

 

[Wednesday]

I had the same problem with constipation, and like you, I dropped the narcotics. Unfortunately, Tylenol and Ibuprofen don't do it for pain.

I am now on Tylenol and Tramadol, which can be taken together. The Tramadol does not seem to have the same constipating effect, but you might also try a stool softener at night. I take an iron pill in the morning and a stool softener at night to balance the constipating effect of the iron, and it seems to be working.

 

[Josephine]

the fact that my constipation has not been resolved

It's quite easy to manage your constipation - don't let it happen in the first place! I took Fybrogel every night in the first 2-3 weeks with good effect. Or there are plenty of alternatives in here Constipation and stool softeners, I understand the "Power Pudding" is very effective!

Only because my quads are so dead. But I just use a leg lifter to help me a I can manage just fine.

That's perfect!

I can't lay on each side very long but it's enough to get some pressure off my lower back.

Well do remember you are only one week out as yet so it will be painful to move positions as you want. However, to ease the pressure on your back, try putting pillows under one side of your back so you are rolled just a little bit. That's often enough and you can still keep your legs as if you were laying flat or you can put a pillow under your upper leg.

Here's a picture of what I mean although I'd suggest you only turn up to a quarter of the way onto your side, just enough to take the pressure off your back. Better than pillows, use a rolled up blanket - softly rolled up so it can mould into a wedge shape

My next challenge is trying to get my pain under control. We are basically starting over and introducing narcotics back into my system.

That's definitely a must - a BIG must! You cannot do a TKR recovery without good pain management. Just remember what I said about being proactive about the constipation too. Just like pain, it's no good waiting until it's happened before you take the stuff. It doesn't work well that way.

Did you read those recovery articles, specially the first one about pain management?

 

[Tamsmom]

Hope you are making progress in the pain and constipation department!

Comfortable sleeping positions are hard to come by...I slept in the recliner for 4 weeks!

Thinking of you.


4/1/2014 TKR

 

[midwest girl]

Thought I would give a quick update. I am now 9 days post op and I think I'm doing pretty good. The issues I had with constipation is resolved. I now do miralax daily and my doctor wants me to continue that for weeks and even months. And he said to add a stimulant like dulcolax every now and then if things slow down. My Coumadin level check on Tuesday shows that my blood is now too thin and I'm slightly anemic. So adjustments to Coumadin are being made. Figuring out a pain med cocktail is getting better and am using Percocet, Tramadol and Tylenol. I'd say most times my pain is with the incision and at night my sciatica. Middle of the night is probably my worst time. But I think I'm close to getting the right combination. Physical therapy is going well. I'm never pushed to pain. Oh sometimes it's uncomfortable when I first start a particular exercise but after doing it 3 times I get in a groove and it really doesn't hurt at all. Every day that I go I increase my degree of flexion by one or two degrees. My extension has never been an issue so far as she says my leg is perfectly straight. I'd say my quad still doesn't listen to me when i tell it to lift but my PT gets me started and I can keep going on my own. Because of the 50% weight bearing there are some exercises I cannot do yet. I'm really glad I have a high tolerance to pain but I definitely don't do any heroics by skipping my meds. Do I still have tears? Yes I do, everyday. Do I have regrets that I did this surgery. Not so far, because I know it will be so worth it in the end.

 

[midwest girl]

These TED hose! Argh!!!!!

 

[Tamsmom]

I thinkI am the only person who liked the dreaded TED hose


4/1/2014 TKR

 

[midwest girl]

Pretty restless night. Finding no relief from pain tonight for knee/leg, back or chest. I'm assuming my chest is hurting from the 50% weight bearing. Also I'm hot then cold. Covers on - covers off. I'm just miserable tonight.

 

[chestnc]

Hi Wednesday, hope you are in dreamland soon. Welcome to this side. Knee replacement is tough without being able to get on top of the pain. That is truly correct. The thing is to try some one to keep on top of the pain and take it regularly as ordered as you are so newly post op. What is it that your OS placed you on? Feel better soon.

 

[Wednesday]

I didn't have a good night until about a week ago. You're still early in the game, and I think we can all relate. The only thing I can tell you is that it does get better.

@chestnc, thank you for that. It's finally happening. Just hope it continues.

 

[midwest girl]

I'm finally in my own home!! Very grateful for being able to stay at my friends home for a week. But there's just something about being in your own house.

 

[susanc]

hello Midwest - remember me? - we both had the same surgery on the same day. boy, my experiences were diff. from yours I believe- I'm on oxycodone and extra strength Tylenol and also gabenpetin - I didn't have any drains and they must have removed the femoral drain during surgery because I only had a catheter to deal with which wasn't a problem. PT came in the first day and I got so dizzy and couldn't breathe that I vomited too. it was embarrassing but they understood. my hospital stay was 3 days because PT wouldn't give me the green light because of my lost of breath everytime I got up - I give you a lot of credit because you actually had the wherewithal to write in the forum - I didn't stop seeing double until the 2nd week! so today is the first day I started up again on bonesmart. All I can say is that I think I cried for the first week and 1/2 - it didn't matter where I was, I didn't care. I'll have to say that I did get waited on quicker or was given easier PT tasks with the crying. I think that phase is over now though! I'm feeling good enough to get up and down out of my lounge chair today better than I ever could before. so things are looking up - This Wed. I get my staples out, how about you??

 

[midwest girl]

Hi @susanc yes I do remember you! If you notice all my posts are in the middle of the night!

My vomiting in the hospital was due to the narcotics. I can't handle taking narcotics regularly day after day. I knew that would happen. The first time happened in the middle of PT and once I was done vomiting I felt great and continued on with PT. The second time I think was due more so from the severe constipation. And I asked the nurse to tell PT that I just couldn't do it that afternoon. And I was fortunate that they gave me a break.

The first 10 days I probably cried at least once a day and usually it was the middle of the night. I just couldn't get my pain meds figured out so it would give me relief yet not make me sick. I think I've finally got it figured out - at least the nights. I take 1 Percocet w APAP 5-325 mg at 10:00pm and one again at 4:00am. That's all my OS gave me besides 800 mg ibuprofen, which my regular Dr wants me to quit taking because of the Coumadin. So during the day I use Tylenol or Tramadol (50mg), which I had pre-surgery or a combination of the two. That seems to work. I don't know if it is because I was staying at a friend's house post-hospital for a week that I didn't sleep as much during the day as I probably should. Now that I'm settled here at home I anticipate more naps! Simple things like washing my hair and getting ready to go to pt takes a couple of hours and is exhausting.

PT is going very well so far. I have to really work to get that quad to do what I want. An issue I've developed now is chest pain and I think it's from being 50% weight bearing. So I'm having to put more weight on my walker, so I'm guessing that it's just stressing those muscles. Everything is going well now but we shall see now that I'm home and will have to be doing everything for myself if my pain and fatigue increases. And if it does, which I'm sure it will, I know how to deal with it. My incision looks good. I have a avg size area to the right of my incision that's completely numb.

Today is the first day that I've left my bandages off. My staples come out Wednesday, hopefully! I may put the bandages back on tonight and leave on till Wednesday just because the staples and/or dried blood gets caught on my TED hose. Overall, at this point, I haven't said "what did I do?" Nor have had any regrets.

Hang in there my friend, it's all baby steps and gets better. We'll see if I say that when I hit a bad day! Haha!

 

[Tamsmom]

Baby steps foe sure! Good to see that you got to your own home! You must be one tough cookie to only use Tylenol at this early stage, I just now do that and not all the time.




4/1/2014 TKR

 

[midwest girl]

Oh I don't just use Tylenol. I take Percocet at night and tramadol with or without a Tylenol during the day & evening. For breakthrough pain I've been using 1000 mg Tylenol. But here at home my Tylenol is 650mg tablets. So now I will have to recalculate my daily Tylenol totals. And I just got behind on my evening meds - argh! But the icing/elevating is working until it kicks in.

 

[midwest girl]

Ever since I left the hospital I have been using frozen water bottles in my ice machine instead of ice. But yesterday I was at a different home so I used ice. Oh my word!! It was so much colder than using frozen water bottles. I loved it!!!! But ice isn't practical for me at home. No freezer space.

 

[susanc]

oh my, you're been through a lot getting those meds right for you, I can't imagine being on only those few meds. - I am one that hates the thought of taking medicine of any kind throughout my life until now, now I'm like a baby bird trying to get as much as possible. I will be happy the day I can slowly come off of them, my primary dr. already told me I won't be on them that long --my OS put a filmy thing on the incision so I could take a shower but believe it or not I could only muster up the strength to just take 1 shower, you are right everything knocks the **** out of you. I think I made a big mistake and set up my PT's for 7AM - so that my husband can get home early to farm. I feel like a zombie in the AM - will just have to set the clock - guess it doesn't really matter. I was reminded by Skigirl of all the post-op info to read (see below) -she is right - I am re-reading it all - I am worried about my PT - I have a feeling they are going to push for good measurement sometime since she keeps taking them during my time there. I am a very weak person who can't speak up for herself, I just don't want them to hurt me. What I don't like is that the assistants work with everyone not the lead PT's. I guess I will have to speak my mind from things I have learned from the Mantras

Also, one more thing..now the insides of each hand are so sore and tender I begged my husband to figure out a form rubber fix - now I realize how much pressure I am using while walking with the walker. It feels like they are black and blue too.

First are the mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

Next is a FAQ (Frequently Asked Questions) thread.

And then the articles in order of importance .
Group A
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it

 

[midwest girl]

@susanc my PT really went better than I anticipated. She has never pushed to the point of pain. To being uncomfortable I'm ok with - not pain. But then again I have a high pain tolerance. Everyone's pain tolerance is different and PTs know that. Just be firm in your resolve. I'm not a morning person so there's no way I could do a early morning PT session. And because I live alone, I didn't want to subject my friends to those early hours. Mine so far have been set for right before or right after lunch. I have the best therapist! I've used her for years so she knows my limits and how far she can push. Remember, they work for you. If you don't like the therapist you have you can always request another. And you can always change your session times. You can do it! Go in with a positive mindset. Let me know how it goes!

 

[susanc]

I will let you know - I go wed and Friday - thanks for the pep talk - I needed that